Failure rates after first-line treatment of localized prostate cancer (PCa) treatment remain high. Improvements to patient selection and identification of at-risk patients are central to reducing mortality. We aimed to determine if cancer aggressiveness correlates with androgen levels in patients undergoing radical prostatectomy for localized PCa. We performed a prospective, multicenter cohort study between June 2013 and June 2016, involving men with localized PCa scheduled to undergo radical prostatectomy. Clinical and hormonal patient data (testosterone deficiency, defined by total testosterone (TT) levels < 300 ng/dL and/or bioavailable testosterone (BT) levels < 80 ng/dL) were prospectively collected, along with pathological assessment of preoperative biopsy and subsequent radical prostatectomy specimens, using predominant Gleason pattern (prdGP) 3/4 grading. Of 1343 patients analyzed, 912 (68%) had prdGP3 PCa and 431 (32%) had high-grade (prdGP4, i.e., ISUP ≥ 3) disease on prostatectomy specimens. Only moderate concordance in prdGP scores between prostate biopsies and prostatectomy specimens was found. Compared with patients with prdGP3 tumors (i.e., ISUP ≤ 2), significantly more patients with prdGP4 cancers had demonstrable hypogonadism, characterized either by BT levels (17.4% vs. 10.7%, p < 0.001) or TT levels (14.2% vs. 9.7%, p = 0.020). BT levels were also lower in patients with prdGP4 tumors compared to those with prdGP3 disease. Testosterone deficiency (defined by TT and/or BT levels) was independently associated with higher PCa aggressiveness. BT is a predictive factor for prdGP4 disease, and evaluating both TT and BT to define hypogonadism is valuable in preoperative assessment of PCa (AndroCan Trial: NCT02235142).
Hormones & cancer. 2018 Oct 06 [Epub ahead of print]
Yann Neuzillet, Jean-Pierre Raynaud, Jean-François Dreyfus, Camélia Radulescu, Mathieu Rouanne, Marc Schneider, Sylvie Krish, Morgan Rouprêt, Sarah J Drouin, Eva Comperat, Marc Galiano, Xavier Cathelineau, Pierre Validire, Vincent Molinié, Jean Fiet, Franck Giton, Thierry Lebret, Henry Botto
Department of Urology, Hôpital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 Rue Worth, 92150, Suresnes, France. ., Sorbonne University, Paris, France., Department of Clinical Research and Innovation, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France., Department of Pathology, Foch Hospital, Suresnes, France., Department of Urology, Hôpital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 Rue Worth, 92150, Suresnes, France., Department of Urology, Louis Pasteur Hospital, Colmar, France., Department of Pathology, Louis Pasteur Hospital, Colmar, France., Department of Urology, Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France., Department of Pathology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France., Department of Urology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France., Department of Pathology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France., Department of Pathology, Centre Hospitalier de Martinique, Le Lamentin, France., Inserm U955, Eq07, Recherches Translationnelles en oncogenèse génitale, Créteil, France.